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Opioid-receptor antagonism increases pain and decreases pleasure in obese and non-obese individuals

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Abstract

Rationale

Endogenous opioids inhibit nociceptive processing and promote the experience of pleasure. It has been proposed that pain and pleasure lie at opposite ends of an affective spectrum, but the relationship between pain and pleasure and the role of opioids in mediating this relationship has not been tested.

Objectives

Here, we used obese individuals as a model of a dysfunctional opioid system to assess the role of the endogenous opioid peptide, beta-endorphin, on pain and pleasure sensitivity.

Methods

Obese (10M/10F) and age- and gender-matched non-obese (10M/10F) controls were included in the study. Pain sensitivity using threshold, tolerance, and subjective rating assessments and perceived sweet pleasantness using sucrose solutions were assessed in two testing sessions with placebo or the opioid antagonist, naltrexone (0.7 mg/kg body weight). Beta-endorphin levels were assessed in both sessions.

Results and conclusions

Despite having higher levels of baseline beta-endorphin and altered beta-endorphin-reactivity to naltrexone, obese individuals reported a similar increase in pain and decrease in pleasantness following naltrexone compared to non-obese individuals. Beta-endorphin levels did not correlate with pain or pleasantness in either group, but naltrexone-induced changes in pain and pleasantness were mildly correlated. Moreover, naltrexone-induced changes in pain were related to depression scores, while naltrexone-induced changes in sweet pleasantness were related to anxiety scores, indicating that pain and pleasantness are related, but influenced by different processes.

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Acknowledgments

We thank Valerie Cotton, Willem McIssac, and Cecelia Webber for help with data acquisition and Samantha AG Backman and Tianzheng Lin for their help with the saliva assays.

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Authors and Affiliations

  1. Faculty of Medicine, McGill University, Strathcona Anatomy and Dentistry Building, Bldg Rm M/19, 3640 Rue University, Montreal, QC, H3A 0C7, Canada

    Rebecca C. Price & Petra Schweinhardt

  2. Alan Edwards Center for Research on Pain, McGill University, Strathcona Anatomy and Dentistry Building, Bldg Rm M/19, 3640 Rue University, Montreal, QC, H3A 0C7, Canada

    Rebecca C. Price, Laura Stone & Petra Schweinhardt

  3. McGill University Department of Surgery, Royal Victoria Hospital, Strathcona Anatomy and Dentistry Building, Bldg Rm M/19, 3640 Rue University, Montreal, QC, H3A 0C7, Canada

    Nicolas V. Christou

  4. McGill University Department of Anesthesia, Royal Victoria Hospital, Strathcona Anatomy and Dentistry Building, Bldg Rm M/19, 3640 Rue University, Montreal, QC, H3A 0C7, Canada

    Steven B. Backman

  5. Faculty of Dentistry, McGill University, Strathcona Anatomy and Dentistry Building, Bldg Rm M/19, 3640 Rue University, Montreal, QC, H3A 0C7, Canada

    Laura Stone & Petra Schweinhardt

Authors
  1. Rebecca C. Price
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  2. Nicolas V. Christou
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Corresponding author

Correspondence to Petra Schweinhardt.

Ethics declarations

The study was approved by the McGill University Ethics board in accordance with the Declaration of Helsinki (2013). Written informed consent was obtained before the first session.

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The authors declare that they have no conflict of interest.

Electronic supplementary material

Supplementary Table 1

Naltrexone effects on current mood. Table S1 displays information on the Profile of Mood States (POMS) scale subscales for ‘elated-depressed’ and ‘composedanxious’, which were used as measures of current depressive mood and anxiety, respectively. Data are shown for obese and non-obese groups and for pre- and post-capsule administration measurements in placebo and naltrexone sessions. There were no significant main effects or interactions for POMS subscales. (DOCX 11 kb)

Supplementary Table 2

Naltrexone effects on pain and sweet pleasantness. The univariate posthoc tests from the significant multivariate analysis of variance (MANOVA) for the effect of naltrexone on the 20 pain measures are shown. Additionally, the result of the ANOVA for the effect of naltrexone on sweet pleasantness ratings is also shown. Means and standard deviations (SD) are shown for obese and non-obese groups in each condition as well as the pooled (obese and non-obese) data. Due to the lack of a difference between obese and non-obese groups, all univariate tests, as well as the ANOVA for sweet pleasantness, were performed on the pooled data. The majority of tests showed increased pain sensitivity in the naltrexone condition compared to placebo condition as indicated in the last column by an upward arrow (↑). Tests in which pain sensitivity or sweet pleasantness was decreased in the naltrexone compared to placebo condition are indicated by a downward arrow (↓). (DOCX 307 kb)

Supplementary Table 3

Reported side effects in placebo and naltrexone sessions. Table 3 displays the median and range of reported side effects at each time point for obese, non-obese, and the pooled results for both obese and non-obese. The ‘TOTAL’ score is the sum of all other side effects and has a maximum value of 28. All individual side effects were rated using a 5-point Likert scale: 0 = None, 1 = Weak, 2 = Moderate, 3 = Strong, 4 = Extremely strong; therefore, the maximum value for all individual side effects was 4. Total side effects significantly differed 3.5 hours after naltrexone administration compared to placebo (p < 0.05). ‘Tiredness’ was the only individual side effect that differed at this time point (p < 0.05). (DOCX 16 kb)

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Price, R.C., Christou, N.V., Backman, S.B. et al. Opioid-receptor antagonism increases pain and decreases pleasure in obese and non-obese individuals. Psychopharmacology 233, 3869–3879 (2016). https://doi.org/10.1007/s00213-016-4417-4

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